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0004 MARK'S PATH
- - - - - `f Me�k :s P�r�= �— A lical ppli i n number t.. ......................................... 0 4A Fee. S .. ....11 ........................................ HAM Building Inspectors Initials........&..D................. 11%• Date Issued.....15� k. ......................... Map/Parcel..3.- ] TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDINGIWINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 4 Mark's Path Hyannis NUMBER STREET VILLAGE Anna Tilio Chase Owner's Name: Phone Number 508-815-9579 Email Address: Cell Phone Number Project cost$ 11,600.00 Check one Residential X Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK E3 Siding Windows(no header change)# Insulation/Weatherization ED Doors(no header change)# Commercial Doors require an inspector's review IN Roof(not applying more than I layer of shingles) Construction Debris will be going to S&J Exco.Dennis CONTRACTOR'S INFORMATION Contractor's name Anatoli Sivitski Home Improvement Contractors Registration(if applicable)#_ 1680 (attach copy) Construction Supervisor's License# 106040 (attach copy) Email of Contractor caoecodinc@gmail.com Phone number 617-710-1001 ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICAN 'S SIGNATURFo, Signature AR & �'� 'Date 4/18/2019 All permit applications are subject to a b ding official's approval prior to issuance. Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement : ntractor Registration Type: LLC - Registration: 182457 BELCAPE CONSTRUCTION LLC F k .� Expiration`. 02/05/2020 42 WOODBU.RYAVE HYANNIA,MA 02601 a`'F •rf Update Address and Return Card. SCA 1 t3 2�?OMM-05//11177 �p p . ✓� 190�72 i'20/L///P,¢GG/o 0�✓/'�CGIJO,Ut/b3P,`�..7• n Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only <atTYPE:LLC before the expiration date. Iffound return to: R Istrlon _ Office of Consumer Affairs and Business Regulation 95 _02/05/2020 10 Park Plaza-Suite 5170 BELCAPE COQftl¢ Ipfi=LG' Boston,MA 02116 !mot ARLOU DZIANIS , ; _' � 42 W OODBURY 1 out signature HYANNIA,MA 02601 Undersecretary Q Acceptance orgsamate The above prices,specifications and conditions are satisfactory and are hereby accepted.BELCAPE CONSTRUCTION,LLC is authorized to do the work as specified. Contract total: $ If acceptable, initial here: Payment will be made as such: I'Deposit 1/3 Start day payment 1/3: $ Upon completion 1/3: $ (0 Date: C/ "`- Signatures: Note:No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. You,the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. r. Accepted By: Date: THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL:4 Mark's Path Hyannis t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ir 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: `t 9-t>-�v/4t City/State/Zip: ffYq6701 Phone#: Are you an employer Check the appropriate x: Type of project(required): 4. , I am a eneral contractor and 1 1.El I am a employer with g employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in employees and have workers' �'capacity. 9. ❑Building addition [No workers'comp.insurance comp.incnranceZ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance ]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.l *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractor that check this box must attached an additional sheet showing the name of the sub-contactor and state whether or not those entities have employees. If the sub-contractor have employees,they must provide their worker'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informatiom d l Insurance Company Name: N� a d.41 c Policy#or Self-ins.Lie.M Rd, 0 4 Expiration Date: 6� O �`LO-2.40 Job Site Address: / 16av Ks' �' City/State/Zip: Attach'a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA forjasurance coverage verification. I do hereby c u pains enalties ofpedury that the information provided above is true and correct! Si Date: Phone#• SO —6" .S� g7afl Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IF 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Anatoli Sivitski Address: 27 Mill Pond Rd City/State/Zip: West Yarmouth, MA 02673 Phone #: 617-710-1001 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 3 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' insurance.$ 9. Building addition [No workers comp.comp.insurance p• required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ✓ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: AmGuard Policy#or Self-ins.Lic.#: R2WC940123 Expiration Date: 06/03/2019 Job Site Address: 4 Mark's.Path City/State/Zip: Hyannis, MA 02601_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the.violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: s� Date: 4/18/2019 Phone#: 617-710-1001 Official use only. Do not,write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Ac o® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYII) `� 1 06/15/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER N MEAC Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY PHOgo,NENo, 508 775-1620 AI o: E-MADDRESS: [suilivan@doins.com 9731YANNOUGH RD INSURERS AFFORDING COVERAGE NAICO HYANNIS MA 02601 INSURER A: AMGUARD INSURANCE CO 42390 INSURED INSURER B CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 281511 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RERT915' CLAIMS-MADE F70CCUR PREMISE Ea occurrence $ MED EXP(Any oneperson) $ N/A PERSONAL&ADV INJURY $. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ . AUTOS Per,accident UMBRELLALIAB OCCUR y EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION X1 PER E H AND EMPLOYERS'LIABILITY Y/N STATUTEANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED7 WA WA WA. R2WC940123 06/03/2018 06/03/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 tl yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1;000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/twd/workers-compensafion/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE •DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Anatoli Sivitski 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673. " Daniel M.Cra y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The A-CORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) -_-� 06,04/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE Or INSURANCE DOES NOT CONSTITUTE A CONTRACT.BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCE!:,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED,-subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT -- NAME: Linda Sullivan DOWLING & O'NEIL INSURANCE AGENCY _PHONE E�). (508)775-1620 (FAX No: E-MAIL ADDRESS: Isullivan@doins.com 973 IYANNOUGH RD INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURERA: AMGUARD'INSURANCECO 42390 INSURED INSURER B: - CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F; COVERAGES ';rRTiFICATE NUMBER: 410125 REVISION.NUMBER: THIS 1S TO CERTIFY THAT THE PO:ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDiCATED. NOTWITiI STAND]NG '�,NY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR M,,W PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY.PAID CLAIMS. INSR - n DDL_St J-5R - POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE �T SID I'A D, POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY -EACH OCCURRENCE $ CLAIMS-MADE OCCUR - DAMAGE TO RENTED �j PREMISES Ea occurrence $ MED EXP(Any one person) $ _ -N/A PERSONAL&ADV INJURY $ G 41'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY❑ � JjECT � LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY j COMBINED SINGLE LIMIT _ $ Ea accident) ANY AUTO I BODILY INJURY_(Per person) $ ALL OWNED SCHEDUL - AUTOS h AUTOS I Wt. BODILY INJURY(Per accident) $ - NON-OVA!F:) PROPERTY DAMAGE I iIREDAUTOS I AUTOS I Per accident $ $ UMBRELLA LIAR u OCCU,: --I EACH OCCURRENCE $ EXCESS LIAB IS INES'1ADE-I I N/A j __ _ AGGREGATE $ P DED I RETENTION$ 0. I $ IWORKERS COMPENSATION X STATUTE OERH 1 AND EMPLOYERS'LIABILITY YIN - U ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? NIA NIA NIA R2WCO23262 06/03/2019 06/03/2020 (Mandatory in NH) " EM E.L.DISEASE-EA PLOYEE $ 1,000,000 II Y�,'.(JeSCfibe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATION£!VEHtCLFS (ACORD 101,-Ar ditional Remarks Schedule,may be attachod if more space is required) Workers'Compensation benefits wi,`',e pair;to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in;,i des other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance Shows t'.o policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate Of insur.nce). The ±alas of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at vvvAv.mass.gov/Is/dhdoirers-coiiil>>eiisation/investigations/.., CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AnatOli Sivitski ACCORDANCE WITH THE POLICY PROVISIONS. 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE - West Yarmouth MA 02673 (; t Daniel M Crowley,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 76(201410.1) The ACORD name and logo are registered marks of ACORD -...y. • TOWN OF BARNSTABLE Permit No. ____27586 Building: Inspector srm l +1 _� / cash un ----------------V _ A o� ,tea OCCUPANCY PERMIT Bond ---___-p____-- Issued to Capricorn Realty Truat Address .r Lot 1, 4 Mark's Path, Hyannis - Wiring Inspector Inspection date Plumbing Inspector _ G < - Inspection date Gas Inspector 0 =_ - —�--, Inspection date —7 lEngineering Department IV 10 Inspection date Board of health q �,� A�. Inspection date /0— R-5 Aver THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON .SATISFACTORY COMPLIANCE WITH TOWN _ REQUIREMENTS .AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....... .......-�............................... is_. ....,. -•:;� yd''., ! , Building Inspector p„�.."';"""m".til,�""y`��zl�"ImTM*°1Zd �aF�ee ray Q rnCa'� Re'p0 Panted On 4�3%2019 �;6,9'� 4 MA_ RK'S PATH, HYANNIS MARS a A w e #,"N G ;19 215 . — a '.fie t �' 1 i 4 1* •. ,•�t,",a'"" Case#: C-19-215 Address: 4 MARK'S PATH, HYANNIS Date: 3/25/2019 Owner Info: Property Info: CHASE,ANNA C TILIO MBL.: 4 MARK'S PATH 271-094-001 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Gas, Plumbing, Low Priority Dept Referral Complaint Summary: Contractor installing new gas generator for sewage ejector for pump station. Plbg inspector advised contractor to obtain permits..Cited concern that unit is larger and may go over property line into property next next door#335 Falmouth. Action History: Action Taken Date Description Fee. Inspector Close Case 3/25/2019 $0.00 andersor Close Case 4/3/2019 Permits obtained as $0.00 andersor required. Inspector Assigned to Complaint: odonnels Filed by: andersor Comments: Comment Date Commenter Comment 3/25/2019 andersor Called Andy Boule of DPW WPC. He stated unit is on public property,,and there is an easement. Their utility bills are billed to $ Mark's Path and that is the address to use for permitting. He is confidant that everything is on public property. 4/3/2019 andersor Confirmed gas permit(G-19-473)and elect permiti(E-19-650)were issued. Grcr.` Ps%a ia'� �r'c."a,�' 9>t ;.�A 4 eau i y 0.« Vum t?�t q ,rk�x r`*'w* � ,w�"�•. � - '� Date: 4/3%2019 :ro°P ' �, - of Barnstable: �, � �..f . v/�IZ'e 1'r_ x ° " � Y+:�. '' ..�. .. a+.:- � $ ✓ ��/,f/s• ti' �'�y., T v�4-'d--w...,..,.•i}„r (Assessor's map and.lot number ypi?N E r0� Sewage Permit number ..... :.. d��.r�........:................. . BARNSTABLE, i House` number a y •k _rae a ........ . � s639. \0� t.. 'FQ MIR a TOWN 'OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....;Construct .Single r:amily, Dwellis TYPE OF CONSTRUCTION .............Wood„Frame...........................................:.................................................. .October...2a...........19..84 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for .a permit according.to the following information: Location .........z,Ot...#.1.....Mark' s Pa th.�...Hvann .S.•....9.4.s..0.r................................................................................... ................... ProposedUse ................................................... .................................. ...........................f.................................................. Zoning District ............R.B....................................................Fire District .............. yam. .iS............ ................................ Capricorn Realt Trust 6 kalmouth RAad R, Annx s Twa.a Name of Owner .........."..................................y........................Address ..7... ......................................9....... ..............• 8. Name of Builde�ranco...Rea....Est.,Dey.CO...JAPAddress .........&,%e................................................................. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms Six Foundation...................... .......................... I?.C.l................................................................. Exterior ..Clapboard;and/or Shingles................Roofing .........Asphalt Shingles .... .................... .............................................. Floors ...Carpet ...........Interior .........ShggtrOck ........................................................ HeatingGas.. '..F.!.W..E1•.............................. .................Plumbing T.W.o... ...............•............................ Fireplace ........NTpne...............................:................................Approximate. Cost ...........4.5.r.0 Q.,.p.Q Definitive Plan Approved by Planning Board ________________________________19________ . Area .....� Q_����...S.!.a ....f't........ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH } u OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS `` N lz� r I hereby agree to conform to.;all the Rules and'Regulations of the Town of Barnstable regardi g the above construction = Name,. ....... �........ s < "`' ...... Construction Supervisor's License 000 $ CAPRICORN REALTY TRUST 27586 One Story No ................. Permit for .................................... ................................Single FamilX I7aelling Location .....4...Mark.'.s..Pat-h................ . ......... .. ......... .................Hyannis......... .................................. Owner Req:kty .... ........Tr.ust................ Type of Construction ..FJ70M............................. ................................................................................ Plot ............................ Lot ................................ ...... .... Permit Granted ...March......7......................19 85 Date of Inspection .......... ......................19 • Date Completed ......................................19 Assessor's map and lot `number ..... ........... � SEPTIC 4��9C SYSTEM 1 E S Rn THE T�� Sewage Permit number .....��I.:/�0.. ..:.................:.......' INSTALLED IN COiA �' o� g/@+ gg ARNSTABLE, i r House number ....... :.......................'. .................... � � � L CODE Al O� 1639.lfJ 1,,2 `00� Ar rY A TOWN. OF �BARNSTA.BLE BUILDING INSPECTOR r APPLICATION FOR PERMIT. ..;Construct Single Family Dwelling r TYPE OF CONSTRUCTION ... . .. ..Wood Frame......:. ....... ............................................................ s-1 ... . .October 23............19..8�'. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to,the following information: Location .........Lot.. 1.....Mark'.s...Pa s.r.,.Maas......................................: t ProposedUse ............................................................... ..:.............:.............................. :..................................::............ I Zoning District .......... R.B. ..............:...................................Fire District .............Hyannis.............................................. Name •of Owner ..•:Ca ricorn Realty Trust Address ..7.6• •;Fa ,?? Qut ... Ra 5�...... Name of BuildWranco...Real...Est.,Dev;.•Co .zIncAddress aMe......:...:....:........... Name of Architect ...::..............:..Address ....... Number of. Rooms Six Foundation .....P.C. ..........:..................................................... Exterior .,Clapboard andlor Shingle•s.,•••.,•,.,••.• Roofing .......:.As-Dha•lt Shingles•••••.••• Floors ....Ca.r. .e t............:........................................................Interior ..........Sh e e trq.Qk.............................. ..................... Heating Gas....-:.F.W.A............ 9 - FIB ............... ....................Plumbin ........lwo.........0 o. Dx........................................... Fireplace ... None ................................... Approximate. Cost ............ .....� ... Definitive Plan Approved by Planning' Board _°/________________________1.9_______. Area t'.t..... Diagram of Lot and Building with Dimensions Fee ` SUBJECT TO APPROVAL OF BOARD OF HEALTH • lb . . C OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of t e Town of Barnstable regar the above' construction. .• . Nam 'res Construction Supervisor's License ....UU 9 s CAPRICC)RNL REALTY TRUST - ."'• j � 27586 No ..:.....8 ..... Permit for ..QnQ..St.QTY................ _. ~ ........Single.FiRt7,J.�?..Janie]Ling. ........ ..........' a Location Lot I....... Ja 4.. x]�' ..P�th. ............ .................. ....................... ..::.......... Owner Real ty..Tru t...:.......... �. Type of Construction ..............Frame............................ Plot ... ..................�... Lot _ .......................... Permit Granted .... .................19 85 - t Date,of Inspec#aar�i.� �... .. ,/ 19�i Date Completed/ ..':f� a •...19 ��, V4� �'��D/=0✓ ', �" vim.• y • .. - �a - a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 7 iap Parcel G1 Permit# Health Division +' /ff —C) Date Issued `C Conservation Divi ion_ 1 P�, Fee ?:3/. uU G Tax Collector Treasurer APPUCAN�'MUST OBT r CO.NNECi IO v PERMIT A SE[, Planning Dep . ENGINr E tINO Dn'IsSION R0NI TITS - CONSTIiUCWPION. PRIOR TO Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address qml��r� T Village f Owner 3 Address / iJ2 e /�1f5 Telephone Permit Request &MOUlt T�J 6 WAS SAP / -j.1�.lJ �1� 1� 6/�(�AC��. -� �'►�TE �t/�C�SS,�i2�, � �2, /'�Y/ � f yG Saw 2 —FI&ML ill 0?�:AaNC Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation /y,aa� Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. • J e Dwelling Type: Single Family ®"* Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes Cl No Basement Type: 811ull Cl Crawl ❑Walkout ❑Other -4\Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new 4, Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name ZEP6< ALA) —.&MM Ze Telephone Number Address 7:!� 3Yl License# C5 ONO YYA OLI60 Home Improvement Contractor# 130331 Worker's Compensation# 007? 17131a ALL CONSTRUCTION DEBRIS RESU NG FROM THIS PROJECT WILL BE TAKEN TO '8QCX;,'1L AZF1LZ_ IGNATURE DATE Vs1111(;ZS r Y y FOR OFFICIAL USE ONLY : MIT NO. y DATE ISSUED MAP/PARCEL NO. { I ADDRESS VILLAGE OWNER' i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL } GAS: ROUGH / FINAL FINAL BUILDING.-'- / 2/ ,c5c:�D ` t DATE CLOSED OUT ASSOCIATION PLAN NO. s _ W TOWN OF BARNSTABLE BUILDING DEPARTMENT S sasasT TOWN OFFICE BUILDING rua �°�► i63q. `� HYANNIS, MASS. 02601 �a r�r►. MEMO TO: Town Clerk FROM: Building Department ` '�` "� DATE: 1 �96' An Occupancy Permit has been issued for the building authorized by BuildingPermit #........�'...� ...:.' .......�...........................:......................... ....................................................._............................................ issued to ... :.... r���rsr�... f.Y...L.�r......,.... c ........ ..� ..��': r �..(. _„ i I Please release the performance bond. �, y Y u r Y s 3 , s • — a n <s r u- r i t' Build new 2x4 partioion wall Proposed Kitchen expansion _ Expand existing doorway to approx 9' ,A y . - - #4 Marks Lath Hyannis, Ma REM2x8 pt sleepers and 3!4 piywooc ' - over concrete. Carpet finish Project by Fra�rrrco 1!8 " =;1'' I� e b II Build new 2x4 partioion wall Proposed Kitchen expansion , Expand existing doorway to approx g' #p4 MarksPath Hyannis, Ma. ® W pt sleepers and 3/4" plywood ' over concrete. Carpet finish 'Project by.Fremco r r -the 1 oWn of Barnstable Department of Health Safety and Environmental Services Fa Budding Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Rahn Crossen Fax: S08-7 90-6230 Building Corr.- Permit no. Date AFFIDAVIT HOME MWROVE MEN'T CONTRACTOR LAW SUPPLEMENT TO PERBUT APPLICATION MGL c. I42A requires that the"recur saucdon,boas,renovation,mpak,modemim -on,conversion, - improy=c r.1 removal,dzmolition,or ca=ncdon ofan addition to any g owner-occupiers building containing at least one but not more tbaa four dwelling tmits ortoto strucn=Which are ad,.acent to such residence or building be done by registered c actors,with cbnain exceptions,along with other requirements. Type of Work: &- -Zi�0L )Z4-2JLC6Tj Estimated cost 4 0000' Address of Woric "-/MwKS Ownees Name: 3 XV't)CV0-405 Date ofApplication: I hereby certify that Regisamtion is not required for the following reason(s): Q Wark excluded by saw QJob Under SI,000 QBuiidiag not owner-oce*cd QOwneerpulling ownpermit Notice is hereby given that: OWNERS PULLING THEM OWN PERNIIT.ORDEALING WrM UNREGISTERED CONTRACTORS FOR APPLICABLE HOME RMOVEMENT WORK DO NOT HAVE ACCESS TO TEE ARBITRATION PROGRAM OR-GUARANTY FUND UNDER MGL c- 142A. SIGNM UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent ofthe owner: tom F&n o J. VC /3Oe<3j Date _ Connacmr Name Regisaation No. OR Date Owner's Name The Commonwealth of Massachusetts Department of Industrial Accidents elfice atindestigatians 600 Washington Street Boston,Mass. 02111 Via.V 5. Workers' Com ensation Insurance Affidavit xxx ;�nni:c uE.tnfaF-nraArrs�✓�/ - name: location: hone# city ❑ I am a homeowner performing ail work myself. ❑ I am a sole proprietor and have no one working in/%/any capacity //iiii%/%/// 1%//% ///%////��%����/%��/%%%%/%%/%��%%%%%%//%/%%%%%/%%/%�%%%///%////ii/„:: Fl.�<am an empiover providing workers' compensation for my employees Working on this job. comnnnv name: address 1S t 13 Id phone insurance co. 20MV 71 � Z ////%/%%/ / /// ❑ I am a sole proprietor, general contractor. or homeowner(circle one) and have hired the contractors listed below who have the follm%ing workers' compensation polices: . comoanv name' address: Z. hone# ' ,. oltcv# insurance co. iiiiii/iii,%/i%//i%i%//i%%/////// comnnnv name. address. s: cith7 _ .. o CV insurance co. ,o ve Failure to secure coverage as required under Section ISA of MGL 152 can lead to the imposition of ctitrntral penalties of a tine up to 51,500.00 and/or one}'ears'imprisonment as well a+civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a e of Investigations of the DIA for coverage verification. copv of this statement may be forwarded to the Offic 1 do nereny cerrif}'under t enalttes of perjury that the information provided above it truo d co ect. - r Date Sigrtamre Print name. D ��. Phone# � 0� :?>�otilcial itse only do not write in this area to be completed by city or town official permitilicense# ❑Building Department city or town: ❑Licensing Board ❑selectmen's Office is check if irruneaiate response is required ❑Health Department € phone#• Other contact rerson: Information and Instructions .Massachusetts General Laws chapte r 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contr of hire, „t-oress or implied, oral or written. : P An employer is defined as an individual partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver other legal entity, employing employees. However the owner of a trustee of an individual, partnership, association or dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds c building appurtenant thereto shall not because of such employment be deemed to bean employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renes of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h: not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contract authority. Applicants Please nil in the workers' compensation affidavit completely,by checking the box of thinsura es affdav at applies e o tits inn be onand supplying company names, address and phone numbers along with a certificate submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is e not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if yc being required requested, eP lease call the Department at the number listed below. are required to obtain a workers' compensation policy,p City or Towns Please be sure that the affidavit is complete and primed legibly. The Department has provided a space at the bottom of affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimitllicense number which will be used as a reference number. The affidavits may be returned t^ unless other arrangements have been made. the Department by mail or FAX The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions• please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Once of levesduatlons - 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 EE -INA TEO PROJECT COST WORfCSl-IEET . Value e LIVING SPACE (high end constriction) square feet X S1151sq. foot= (above average construction) square feet X S961sq foot= (average construction) square feet X S571sq foot= GARAGE (LJN MSI-IED) square feet X S25/sq foot= PORCH square feet X S201sq.hoot= DECK square f ntX S151sq.foot= OTHER � d1 ..feet X S??/sq. foot .�� '' - Project Cost A °Q . - - --. Total Estfmated i A �j T BOARD OF BUILDING REGULATIONS'— 'Y License CONSTRUCTION SUPERVISOR Number CS 077263 ! " �� Birthdate 06/18%196 1�.+ y�t�?/'. i i Expirs ti06/ 8�2004�e r.no: 77263 Restricted To,-, r r DEREK M LINCOLN :' 28 SKIPPERS DRIVE' ( .,� ��;v��'�� 41 !i HARWICH, MA 62645 Administrator fie C�ommarrc�� o���eG yoard of Building Regulations and Standards One Ashburton Place - Room 1..301 Boston , Massachusetts 021_08 , F�orne Improvement Contractor Registration Renistration:' 130831 _Expi.ration : 04/25/2002 Type ." Private Corporation HOME IMPROVEMENT CONTRACTOR Registration: FRANCO INC Ezpiration04/25/2002 DEREK LINCOLN Type: Privahe-Eor 35 ROUTE 134 YP -PoTaTi o SOUTH DENNIS NIA 02660 FRANCO INC &o VX LINCOLN ADMINISTRATOR 35 ROUTE 134 SOUTH DENNI MA 02660 f 00-35,000 cf enclosed space (MGL C.112 S.60L) } 1A-Masonry only G, 1. 1 G-1&2 Famlly Homes it Failure to possess a current edition of the Massachusetts State Building Code 1 Is cause for revocation of this license. DIG SAFE CALL CENTER: (888)344-7233 Change in license or registration application. Complete the form below. (Print or Type). Send to the mailing address on the reverse side.Mark reason for change. ❑Address ❑Renewal ❑Employment ❑Lost Card ❑Other Last First Mid I License or registration valid for individual Company(If any) use only before expiration date. If found return to: One Ashburton Place Rm 1301 Boston Ma.02108 Mailing Address City ST ZIP TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map e7 1 Parcel D Application # �® Health Division Date Issued/2—to Conservation Division Application Fe - ,' Planning Dept. Permit Feei Date Definitive Plan Approved by Planning Board Historic -OKH _ Preservation / Hyannis Project Street Address y lY�S oA) Village 'M% nvh.1 S Owner n a epttoVi(12 A'a ChA-se Address 5QY" above Telephone ��Oi) I is q5 g � Permit Request��- � e rr� C e bp,VnNz4- Ago . c ° -M�bo a,/0 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District /� Flood Plain Groundwater Overlay Project Valuation 6, 0400 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (#,'units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wo / oal stop: ❑ s. LlNo Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: existing ne\;F size_ '� r7 0 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other:O Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ O° cx� Commercial ❑Yes ❑ No If yes, site plan review # co Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER] Name k"na C- f I�jb C.I�mle, Telephone Number t Address ftr IDS License # a Home Improvement Contractor# _ Evinlail ° Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SlIGNAT E DATE 0 E - FOR OFFICIAL USE ONLY ,+ APPLICATION# ~ DATE ISSUED MAP/PARCEL NO. 'f r ADDRESS VILLAGE OWNER r _ { DATE OF INSPECTION: r : ,-FOUNDATIONiu.�tt%Qj4iu-rv',Llv4Utl;jh. ^ ° FRAME rn ,,INSULATIONi FIREPLACE ELECTRICAL: ROUGH FINAL' E PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING`. j , DATE CLOSED OUT ASSOCIATION PLAN NO. ' r 27je Cmnffiomvwkk Of Ma3waa zffdfS �e�vrrrtm t atIndw*id Acdd hw& .600 WashiagtouSMed BoAwu MA O21U www vMMgov1dw Workers' Compensafian Insurmice A�i BuU&-r-J sd'kmbers Aunli Informaficm Please Prim 'bl� Name s �°-na Address=—CitY 'JI�S �q /Statezip: fk 07-�O � ,'S Are you im wgilpyk Cheek the appropriate bo=: �_- Type of Foject(requimA: 1.❑ I am a employer vfth 4 ❑I am it general canfraetor and I 6. ❑New Co sfrwaon employees(fall aatflarpatt-lime).* have hued the sub-cmiactm- 2.❑ I am a sole proprietor orpart mr- listed aathe attached sheet 7- ❑Rmaodeling ship and bare as employees Them uh-c gtactors have 8- ❑Demolition wcddng forme in any capadtp employees=d bate q. ❑Bm7dmg addition INO ttivd='comp.insurance Camp.insruaace.X f` �] 5. ❑ We are a co>poutionand its 10-0 I1echical1epsim er addi i= AI inn a homeowner doing all work officers bane cmrcised ffieir MO Piumbmg mpam m-addttians uysel£[No wad]me cutup right of exemptionper MGL insurance required.]t c-15Z 11(4�and we have no 12-❑Roofsepaits employees-[No Wad= 13-❑Other comp-iasorance required.] •Aapappfic��te�dabasgltamsia]sofiIlordtheserfieabeIomshesria5iheeawad�eis'comPP�p��� I Hmnwwnem Rho sub=ft Ws dfidavit in sobudt anew ffidavid indite sech. kCoat Mmlbat check thisbam most notched m additional shert shotriagtl>ensaaenf the sat�cemxsctaa and slue Rhetha ornQtthase eatitiesIu� employees. Iftba so7rtoatacmt lm employees,2hey—vvr mvMe tmcir warkme comp.poEcymmmbes: lam an eutptnytr this prnvidirzg nrorkera'catnperrscction utsrtraz7tGes for my empinyses $aTetF is Siepalicp etrd jvb silo irtfot�rtrafirat1 IflsMMM Compaayr Nine: Policy gab or Self-ins lie-#: FxpixafiionDate: Job Site Address_ �'atylStatelTp: Attach a copy of fha wozirn'compensafiou policy derbration page(showing the policy number and ezpi at iaan date). FaRure to secotre coverage as required uncles Section 25A of MGL a 152 can lead to the imposition of•t•=iminal penalties of a fine up to$1,50D OD andlor ono-gear imptssoumest,as well as ai vd penalties is the hum cf a SMP WORK OI3DERa d a fine. of up to S250-00 a.dap against the viohator. Be advised that a copy of thus statement maybe firwarded to the Office of Iavestigati=of the DIA for ins=mre coverage verification. I de hereby er*nnrier•the pains nndpenzMgr ofperjwy fltagtfbs kformucrmt pwvs'deti is tore and carraact 1 Phaue# i ©, uss auF,}s Do mf writs fit Ah wwai to but camplsted by city'azrf w axfrckE Carty or Tvw= PermftUcense f Ong {mrIeant)~ L Bw d of Hsafth 2.$tldiag Da wfineat I CA.WTaim Clerk 4.Electrical Inspector 5.Pmmrbmg r Lather Contact Person: Phan 6 . 'k Town of Barnstable Regulatory Services HE Richard V.Scali,Interim Director Building Division sAWMAJ= Tom Perry,Building Commissioner amass. 9� 16j9* ��� 200 Main Street, Hyannis,MA 02601 A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6290 HOMEOWNER LICENSE EXEMPTION {'j • i Please Print DATE: l "� �✓ 1 JOB.LOCATICK Vs' l CY - 1 number V1 street 1/{ . R cvillage "HOMEOWNER": name home phone if work phone# CURRENT MAILING ADDRESS: c /tom state up c de The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit.' (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The dersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection proc dares and re air ents and that he/she will comply with said procedures and requirements. i ature of Homeowner `1 Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems;.particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person.as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. di ermitformslEXPRESS.doc i r �TME Town of Barnstable Regulatory Services '�'� Richard V.Scali,Interim Director i63q. �0 Nua" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date " 1st leval front bedroom N room stairs co Lu -j U co Cn �Y `a storage aerea bedroom o .- kitchen libathroom bathroom SMOKE DETECT S REVIEWED back yard CM S BEOOIDEALARMS INSTALLED PER ILDING PT. DATE MASSACHUSETTS BUILDING CODE BARNSTABLE BU FIRE DEPARTMENT DATE BOTH. r',l,NATURESARE REQUIRED FOR PERMITING Basement oor 10 M front _r platform w Energy Star Basement Storm Window office �4 q Family Room m Family Room rn c .. a � �a ylw►SUS �v, e storage room C el ;VN Family Room Unfinished = storage room 112 Bath laudry roo V , IT .i t' x c3 r, f n IM R _ t Unfinished area 897 sf back yard Finished will be 684 sf Bulkhead Acess 0 Smoko- ecto\r Jl� ],C,5oACkAkO r, ce \` •IV)G >�- 13 Wa`� V� ci�e�' �ec�I e ►' �/�`t 5� ee� f� c K R �/y fe wnO), Y�a 5 Basement �)( t5�lr�g front i e6jplatform a Energ%.-Star Unfinished Basement Storm Window 0 0 Unfinished Q 0 Unfinished ( Unfinished Laudry Unfinished area 897 sf back yard Finished will be 684 sf Bulkhead_Acess 0 L� W CA4 V- �n a h TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map , .—Parcel-0��� 1 Application # 6 Health`Division Date Issued to Conservation Division Application Fee Planning Dept. -Permit Fee Date Definitive Plan:Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 14 Village If Own IR 1 tl 0 U ftsE Address M"K S "t ✓Telephone C56 Veb-' `5_-� i Permit Request 0 b I a ` n A&r+_ se, sir+mvs r �Sees a yd s Cram Zvi -1 CAl ' A �c�st �t? s Square fe : 1 st floor: existing proposed 0 2 r: existing D proposed A�otal new Zoning District Flood Plain Groundwater Overlay! Project Valuate;( LOn)Wukn'Type f �'-r� — Lot Size Grandfathered: ❑Yes ❑ No If yes,'attach supporting documentation. Dwelling Type: Single Family M/ Two Family ❑ Multi-Family (# units) 'Age of Existing Structure 126 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: dFull ❑ Crawl ❑Walkout ❑ Other Basement Fin' Area(sq.ft.) 1� (�Basement Unfinished Area (sq.ft) () `I j Number of Baths: Full: existing 4-:21 new O Half: existing new Number of Bedrooms: ..� existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 'd Gas ❑Oil ❑ Electric ❑Other Central Air: Yes ❑ No ✓Fireplaces: Existing New Existing wood/coal stove: Yes XNo 0 c� O Detached garage: El existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑Ming '❑mew maize_ o a Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: � o na i z Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# r Current Use Proposed Use ► ' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Na 'c��-GoS I11,eYt�� Telephone Numb r � o, fl Address Nby�� License # 1..0 410 Gyu PA- IJeak,yn AA4 Home Improvement Contracto # i5'3z 0 Zero 1 Worker's Compensation # W -2o 1OX0 92 yo3 AL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' 1, SIGNATURE DATE ``Zo 1.22 0/0 , f { FOR OFFICIAL USE ONLY { APPLICATION# i DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: }. i ` FOUNDATION, a - s FRAME ` INSULATION } FIREPLACE ' ELECTRICAL: ROUGH FINAL , PLUMBING: ROUGH FINAL t •FGAS:- ROUGH FINAL . :FINAL BUILDING. �, � ; 1 -DATE CLOSED OUT y 1 ASSOCIATION PLAN NO. i r The Commonwealth of Massachusetts. Y Department oflndustrialAccidents Office of Investigations 600 Washington Street t� Boston, MA 02I11 Lsy www,m ass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name (Business/Organization/ndividual): Address: 2-0ki N G C S cR ity/Statt/Zip: G6 U phone #: j®& -A Are you an employer?• ec the appropriate box: Type of.projecf(required): 1. F9 I am a employer with 4. ❑ I am a general contractor and 1 have'hired the sub-contractors.. 6. ❑ New construction employees(full and/or part-time). - --- --- ---- — - - - .. - 2.rl�2I am a sole proprietor.or partner listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition No workers' comp. insurance comp. insurance.1 required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 1 LD Plumbing repairs or additions myself. [No workers' comp. right of mrmption'per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.[:] Other comp. insurance required.) "Any applicant that checks box fl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and stale whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the poli`y and job site information. Insurance Company Name` 064a_� �5 0 r5 ce; Policy# or Self-ins. Lic. #: L PO-&bo-iQpnCA a,^,'r3 Expiration Date: �I m � T City/State/Zip: 1 S � Job.Site Address: Attach a copy of the workers' compensation policy declaration page (showing the policy num date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby e tinder the pains andpenalties ofperjury that the information provided above is tree and correct. Si nature: -a Phone#• >SO Official tcse only. Do not write in this area, to he completed by city or towrt official City or Town; Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector 6. Other Contact Person: Phone#l: hformation and fnstructzons .. Massachusetts General Laws chapter 152 requires al) employers to provide tivorkers' cornpe.nsa(ion for their employees., Pursuant to.this statute, an employee is defined as "...every person in the service of another under any con(raci of hire, 'express or implied, oral or written." 'An employer is defined as "an individual, partnership, association, corporation or other legal ebtily, or any two or more the legal representatives of deceased employer, or the engaged in a 'oinL enterprise, and including g p of the foregoing � P receiver or trustee of a❑ individual, partnership, association or other legal entity, employing employees, However the e than three apartments and who resides {herein, or the occupant of the owner of a dwelling house.having not more p to do maintenance., constriction or repair work on such dwelling house dwelling house of another who employs persons or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renevYal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage require,d." hall Additionally,MGL chapter 152, §25C(7) stales "Neither the commonwealth nor any of its political subdivisions s enter,into any contract for lheperfonn ante ofpublic-work until acceptable evidence ofcomp]iance with the insurance requirements of this ehapierbave beenpresented to the contracting authority." Applicants Please fill out.tbe workers compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contraetor(s) name(s), addresses)and phone nurriber(s)along with their cerlificate(s) of insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees other than the members or partners, are pot required to cary workers'compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of lndttstriaJ Accidents for confirmation of insurance coverage. Also be sure to si.Dn and date th-e affidavit. The affidavit should be rettuned to the city or [own that-the application for tho permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a,workers' compensation policy,please call the Department at the number listed belopr, Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom Of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permiUlicense number which will be used as a,reference number. In addition an applicant that muss submit multiple permii/Iicense applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" ibe applicant should write"all ],canons in _(city or town);"'A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicanf as proof that a valid affidavit is on file for future permits or licenses. Anew affidavi t'lnust be filled nit( each year, Where.a home owner or citizen is obtaining a license or permit not related to any business.oreommercial venture (i,e, a dog license of permit to bum leaves etc.) said person is NOT required !o complete this afdavil• The Office of lnvesligat�ods wou ikeTo Yh�nkyun�n✓adva j-0 °ornecal,'nn and shou➢d youhaye any questions, please do not hesitate to give us a call. The DeparLmeni's'address, lclepbone and fax number: The Commonwealth of'Massa,chusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, # 61 7-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-)27-7749 Revised q-24-0 www.mass.gov/dia I AIYC Gi de to 61%od Consfructioii in. ffi, h IKiad flreas:110111pk Wind Zone Massachusetts cheel ist fow Co III p.lz III Ce (780 CII,IR 5301:2.1.1)`1 Check Compliance 1.1 SCOPE P Wind Speed (3-sec. gust)................... .1 . ................ �`..... .. ................................. .•..... 110 mph Wind Exposure Category { Wind Exposure Category............ Required For Entire Project ....................................... 1.2 APPLICABILITY Number of Stories (a roof w h exceeds 8 in 12 slope shall be considC ed a story) stories s 2 stories' Roof Pilch ....................I.......�•............... ... . .. .............(Fig 2) .....b�..:.�..s.�� •....:..... 5 12:12 AZ Mean Roof Height .................... �� (Fig 2):.:...:..•....:»._,..::.....•...;:..:........ ft 5 33' �...(..�... .. . .... .................. Building Width, W ........................ _.. ....... . ....................(Fig 3)...................... - _ ft <80' Building Length, L ......•...................:.- ........•................(Fig 3)...................:................ .......... BuildingAspect Ratio L/W .......(Fig4 �._ Nominal Hei ht of Tallest O enin z ..... . r 9 P 9 ,.....(Fig 4)._...........................777177... 6'8" 1.3 FRAMING CONNECTIONS U (�/,)/✓�' 1 o� General compliance with framing connections.:.:. {Table 2).:...I..�...... •........I.....1..... �...:..: 2.1 FOUNDATION z Foundation Walls meeting requirements of 780,QMR,5404.1 �� Concrete.............................................: ,....Ii....•... ( .:..., ....0 ................., Concrete Masonry....................................•---.— :...:............. ...............:..............................a.......... ...... 2.2 ANCHORAGE TO FOUNDATION1'3 5/8"Anchor Bolts:Imbedded or 518"Proprietary Mechanical Anchors as an alternative-in c ncrete only BoltSpacing-general •....................•...: ..I..........:.(Table4)•....................,......• ... ............ in. Bolt Spacing from end/joint of plate .•.•..•.. ....................(Fig 5)..................:. ... in. <6"-12", .......... . Bolt Embedment-concrete.................. .....................(Fig 5).••... ..................I... ...................._in. >_ 7" Bolt Embedment-masonry................ .:......................(Fig 5)............ ............. ...I........::... in. >_ 15" Plate Washer........:..................... .... ..............•..........(Fig 5)................ ...:..:: ..............:...... >3"x 3"x ,/4" 3.1 FLOORS C x l 1'/". Floor framing member spans checked .... "'—.,(per 780 CMR Chapter 55 .. ........ ........... (p p . Maximum Floor Opening Dimension..............r,..........(F)g 6).......................I............................_fts 12 Full Height Wall Studs at Floor Openings less than 2' from Exterior Wall (Fig 6)...........:. Maximum Floor Joist Setbacks Supporting Loadbearing Wails or Shearwall................(Fig.7)...................................................... ft :5 d} h Maximum Cantilevered Floor Joists Supporting Loadbearing Walls'or Shearwall -(Fig 8)... ......•.... .....•._ft s d V` Floor.Bracing at Endwalls..............:.........•............. :... (Fig 9).... .................... .. ... .::....................... Floor Sheathing Type ..'....,..•............................... ..... (per 780 CMR•Chapter 55) Floor Sheathing Thickness............................ ...............:..(per 780 CMR Chapter 55)...... in. (� Floor Sheathing Fastening............ d nails at Kedge —:in veld .1 WALLS Wall Height Loadbearing walls........•.:..... .. ... .. .. .:.. (Fig 10 and Table 5)•..........,.. ." —ft :510' . ....N Non-Loadbea�iarJ vraJls .. (Fig 10 and Table 5)....... :;Q.... ft s 20' Wall Stud Spacing �• ll �.�/:.... (Fig 10 and Table 5)...,.. in. :52 o.e. Wall Story Offsets ,•,:...•......•(Figs? & 8). — ft d 2 EXTERIOR WALLS'' ry il•Gj t(AJ Wood Studs Q Loadbearing walls....... .............. .......•... ..... ...........(Table 5).... 2x— —ft—in. Non-Loadbearing.walls.. ... .... •..... ....... ... ............•(Table 5).... ..... .. . I. ... .....2x_-_ ft—'in. { Gable End Wall Bracing i Full Height Endwall Studs............................................(Fig 10)........ .......................... WSP Attic Floor Length ........................ (Fig 11) ....•...... ft zW/3` 'Gypsum Ceiling Length(if WSP not used)_. ....,.(Fig 11).............. ft 2: 0.9W and 2,x 4 Continuous Lateral Brace.@ 6 ft. o.c'.. (Fig I I):..!.... .......... ... or 1 x 3 ceiling furring strips @ 16 spacing min. with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays_ Double Top Plate Splice Length ..(Fig 13 and Table 6)............. ....... ft - Solice Connection (no. of 16d common nails)..............(Table 6).......................... 1f kVC Guide l0 6410od C011,t•lrr1C6011 irr. Hi,q/i 110 fipb Hlil-ld zorfc l-lf,'1SS21C)lIISett,S .Cl1L4C.ICI1St f6l, C0I21PJ1.R11Ce (780 Cr1,IR5361.2,1.1)� Loadbearing Wall Connections t ti� ti 0 Lateral no, of 16d common nails ................................ Tables 7 Non-Loadbearing Wall Connections Lateral (no. of 16d common nails).......�.�.�..�! ! Table 8 Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans .r......, ...........(Table 9) ":.........._ft_in, 5 I V Sill Plate Spans ............................., .................(Table 9)....................�......._ft_in. 5 I V . Full Height Studs (no. of studs)...............:.....,.(Table 9).................................................,...... Non-Load Bearing Wall Openings (record largest opening but check.all openings forz_�iance to Table 9) Header Spans.......:.....:...............................................(Table 9)............................... .._.ft_in. 5 12' Sill Plate Spans.... .................r—..............................(Table 9) ...... ft_in, 5 12„ Full Height Studs (no. of studs)..................................'..(Table 9)...........,................. -....... ....... Exterior Wall Sheathing to Resist Uplift and Shear Sim Itaneously4 Minimum Building.Dimension, W. &JCI r'& Nominal Height of Tallest Opening2 _<6'81, ............................ Sheathing Type.............`!...! ..:.................(note 4)..................................................... Edge Nail Spacing .......... .............. (Table 10 or note 4 if less)........................ in. Field Nail Spacing ........................(Table 10).................................................. in. Shear Connection (no. of 16d commolT nails)(Table 10)....................,........I........:................_ Percent Full-Height Sheathing...................:...(Table 10)..........................I..........•..:............._% 5%Additional Sheathing for Wall with Opening > 6'8'(Design Concepts).................... Maximum BuiNominal Dimension, e /xe��) Nominal Height of Tallest Opening2. .;.......................... . .........................................._5 6'8 SheathingType..............................................(note 4)...........,......................................... Edge Nail Spacing..........................................(Table 11 or note 4 if less).....,.................. in, Field Nail Spacing.......................................:..(Table 11).............................. ... In. Shear Connection (no, of 16d common nails)(Table 1 ................1)...............:.........I.............................— Percent FUII-Height Sheathing................. .....(Table 11).........,....... ..........._% ............ ......... .. 5%Additional Sheathing for Wall with'Opening > 6'8"(Design Concepts).................... Wall Cladding Rated for Wind Speed?-....:......................:............ ....., ....... 5.1 ROOFS Roof framing member spans checked?.......:...... .....(For Rafters use AWC Span Tool, see BBRS Website) Roof Overhang .............. ..—.......:...........,......(Figure 19) _ft<smaller of 2'or V3 Truss or Rafter Connections at Loadbearing Walls Proprietary.Connectors Uplift...................... . ...... ............... Table 12 ......:.................... - p ( ) U- plf Lateral............ ...............,..............(Table 12).............................................L= plf Shear....... ...........:.......:..................(Table 12)...................................:........ S= plf . Ridge Strap Connections, if collar ties not used per page 21... (Table 13)..................:..........:. T= plf Gable Rake Outlooker...................I...................,-.,(Figure 20)............... ft s smaller of 2'or L12 ' Truss or Rafter Connections at Non-Loadbearing Walls. Proprietary Connectors Uplift................,,..;............................(Table 14)............................................U= lb. Lateral(no.#1.1?Dmnipnail )...(Table 14)........:.............................. - Ib. Roof Sheathing Type............. . t .(per 780 CMR Chapters 58 and 59) ... . . .Roof Sheathing Thickness,,.........f. . ....�:le.y�.....1 ...................... c in. _> 7/16"WSP RObf�fie2ir1^ C^�t£i��fl /l I /y....:.... '.. �. ...............:...r.. .. .. ............��� .............. ................... es: This checklist shall be met in its entirety, excluding the specific exception noted In 2,'to comply with the requirements of 780 CMR.5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the.WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 1 i C. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b xception: Opening heights of up to 8 ft. shall be permitted when 5% is added to the percent full-height sheathing quirements shown in Tables 10 and 11. .'he bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade.. Town of Barnstable' , Regulatory Services MR1f5LABLE, • . v MAss g Thomas F. Geiler,Director LD Building Division Tom Perry, Building Commissioner .a 200 Main Street;Hyannis, MA 02601 www.town_barnstable.ma.us Office: 508-862 4038 Fax: 508-790-6230 Properly Owner Must .Complete and Sigh This Section If Using A Builder - 7 n a Camll"na I i �l)- as Owner of the sub)ect.property hereby authorize it r/GiWiAO A to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) 6 nature of Owner , Date.. lml9 Peat Name : R. f ♦J. If Property OwYaer is applying for permit please complete. the Homeowners License Exemption Fonh on the rever8e side. , a Q:FORMS:o WNFRPFRM1SS)DN � 04 Y�ray Town of Barnstable Regulatory Services stt:rrsrtisr� Thomas F. Geiler,Director �P 65P. ,$� Building Division rfo►n�'t'' Tom Perry,Building Commissioner 200 Main-Street, Hyannis, MA.02601 °• www.town-barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EfOnIEOWNER LICENSE EXEMPTION 's Please Print DATE: JOB L OCAMN: /`SB49N S number street village 7IOMLOWNER": (5C6)8v�— >s`�g name home phone# wolf phone# CURRENT MAILING ADDRESS: city/town state zip code Tbc current exemption for"homeowners"was extende to includ owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire wh ors D t possess a license,provided that the owner acts as- sup eryis o I. DEFINMON OFEO 0WNTR `', .•,� •t Persons) who owns a parcel of land on which he/she resides or ' ds to'reside, on which there is, or is intended to' be, a one or two-family dwelling, attached or detached slructur s acce ory to such use and/or farm strictures. A person who constrgcts more than one home in a two-year peri d shall no e considered a bomeowner. Such "homeowner"Shall submit to the Building Official on a form cceptable to Building Official, that he/she shall be responsible for all such work performed under the building rmit. (Section 1 �1.1) The undersigned"homeowner"assumes responsibility for c liance with the State ding Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner" certifies that,he/she unders ds the Town'of Barnstable Building eparttnrnt minimum inspection procedures and requirements and that e/she will comply,with said procedures and requirements. Signature of Homcowncr • Approval of Building Official 5 Note: Three-family dwellings containing35,00 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNE 'S EXEMPTION .The Code states that: "Any homeowner performing work f which a,building permit is required shall be exempt from the provisions Of this scc.tion.(Sccdcn 109.1.) -Licensing of construction Supervisor ;provide`d that if the homeovmcr engages a pason(s)for hirz to do such work, that such Homeowner shall act as supervisor." Many homeowners who use this rxemptiomare unawvz tha they are assuming the responsibilitics of a supervisor(see Appendix Q, Rulcs&Regulations for Licensing Construction Supavison•,Section 2. 5)•This lack of awareness.oftc m d msulis in serious problems,particu)ar)y when the homeowner hires unlicensed persons. In this case,our Board c nnot proceed against the unlicensed person as it would with a licensed Suprnisor. The homeowner acting as Supervisor is ultimately responstb To ensure that the homeowner is fully aware of his/her respons-i i)itin,many communities require, as part of the permit application., that the homeowner certify that hcJshe understands the msperoslbi)itics of a crvisor. On the last page of'this issue is a,form currently used by O several towns. You may cart t amend and adopt such a form/ccrtification for use in your community. f� Q:fon-ns:h omccxcmpt f Massachusetts Workers' Compensation Insurance Plan Acadia Insurance Company Administered by Berkley Risk Administrators Company, LLC PO Box-1100, Mpls, MN 55440-1100 222 S 9th St, Mpls, MN 55402 Acadia Insurance° Phone(605)945-2144 Fax (866)215-8118 Toll Free(800)634-4589 NCCI Carrier Code 33391 CERTIFICATE OF INSURANCE 1. The Insured: WCIP Policy Number: WC-20-20-000092-03 C Carlos Figueiroa s Tax ID#: F 01-8723094 dba: C N F Remodeling 20 Captain Noyes Rd Policy Period: From: 5/1/2010 South Yarmouth, MA 02664 To: 511/2011 Date of Mailing:7/27/2010 The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or after the coverage afforded by the Policy listed below: This is to certify that the Policy of Insurance described herein has been issued to the Insured named above for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this Certificate may be issued or may pertain, the insurance afforded by the Policy described herein is subject to all the terms, exclusions and conditions of such Policy. APE OFIISIlRANEF .... .. Coverage Part One w ,: , . State(s) Workers'Compensation Statutory MA Part Two Bodily Injury by Accident $500,000 each accident. " C J' Employers'Liability Bodily Injury by Disease $600,000 policy limit. Bodily Injury by Disease $500,000 each employee: Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. t All Entities/Insureds: Certificate Holder's Name and Address: Figueiroa Election Election Earth Safe Inc Category Status Name Steve Orbe Sole Proprietor Include Carlos Figueiroa 140 Pleasant Lake Ave Harwich, MA 02645 Date Issued: 7/27/2010 Leonard Insurance Agency Inc - -. 7 Wianno Ave ;f Osterville, MA 02655 ..•... � y`"�� «- BA 3140 Nlaasacllu ctt, -I)cflartillcnt of Public sitfct% Biru•d of Budding Re-utllatinil anti Standard,- - y Construcfi ti SuPerv.isor 1-icetlse License: CS 104107 CARLOS FIGU.EIROAY i 20 CAPTAIN NOYES RD SOUTH YARMOUTH, MA 02664 �--�- -� Expiration: 8/25/2013 V unmi s•i mi r Tr=: 104107 aolz�as!ulw voszo dw`Hlnowa �:s `62 SgXON NI` J-d`dO OZ yOiil3now SOlbvO !d9O aifl ' �iozrsi� 595ve', I o!�¢��Slsab �i Z6L£5L IOU 2jOlO�1Noo J." 3nCddW13WOH rye/uespoiaejn2ag ui9lfngl0Pasog ' n �arynopatc:t�io•�l. 1. l Failure to possess a current edCiti de of the Massachusetts State Building is cause for revocation of this license. -Refer to: WWWMass.Gov/DPS 1 � License or registration .:;lid for individul use only before the expiration hate. if found return to: Board of Building Regulations and Standards One Ashburton Place iZm 1301 Boston,Ma.02108 Not.valid will:out signature L l ' G } a �\ �r ci s CID V! e— o - Whalen Restoration Services Inc. 22 American Way,Dennis Ma 02660 Crew's Daily Work Log Employee: Sirs , �,or: Day: t 4° Crew: t _ Job Name: I Time In&Out: Destination: Materials: 7:00 8:00 Basement front N 55 N 10 19` ro platform a v v Filoffice Family Room Family RoomCo - 1 (p 1 o° 10, 3 _ m - 9 Louvered vent Family Room = ., Family Room 12" oD, storage room Ln co Idudry room iO 6 m v, r„ w CD 18' m CD lx� -a - n S rn r'�' `t7 � o m C5 p cn m rorn n r- _ o z O L7 vm :Unfinished area 897 sf back and o oon Finished will be 684 sf o o -H 9 e S m n m CDBulkhead Acess &5 rn — c n rnn p � -n -- rn D y n O SS Ica R, � cn cnQ porn = xrn -i c �3 CD m m ^' rn pm c M Cn Czo zrn0 Ory�j max � rnT o zn •-�� o oT � S S rn O z �a S o�� � m ozo C7 T 1 IN II d u N C! N w fUO V U U V U Upp W vim- Cr C cc Cr ce fY1 V V • M � rVy� U V V V V a' Cr ai - e�i eMd e1 O C C C C C C O O O O O O N •� � fp f�6 t0 t~0 •f0 f�6 w > 7 3 = C = C C C N N C C 16 OC 16° OC 16" OC _ 16" OC 16" cc 16" OC 161, oc e'� OC �t; r wall insulation R 13 craft face s, 2" X 4 " walls 16" on center ` Wall Framing 2" X 4" 162C wall insulation R13 Ceiling Insulation R19 Finisher walls 1/2" Drywall _ Finishe Floor Fergo Floor Finishe ceiling 2'X'4tiles Electric To CODE 1st leval front -� bedroom TV room stairs -- ---- -- ��._--—' storage aerea bedroom bathroom -- - kitchen _-� • • bathroom F L back yard REVISIONS: TEST PIT DATA DATE of rEsr/NG: } �/ I l ____ _ PERC. TEST DATA SEPTI C TANK DETAIL : sIzE- - b oo - - GAL, DIST, BOX DETAIL : LEACHING FACILITY DETAIL: NO DATE -� �h< < < 4� v_ �/ne swo ELD R TC'-7> E1.�G C 4 - 5. L U 1s�Y l A' !�:'I r c/a TEST BY� - - - DATE OF TESTING I r ` I��`�� TO CONFORM TO TIT, c 5 RE0b,1REMFNTS s�rtf TANK TO CONFORM TO TITLE 5 REOLiREMENT r F' 7 p WITNESSED BY: —-- -- -- E-�EV TEST BY LL70 G,C.n• - s. v>rUE� NO. OF OUTLETS, -- - I . l� 1 __ - ,M .d, �tlh KEGGc�4rf- SEnnc _ Y r5ir. te y/sQ_ ' -- -- - - -- - - - W/TNESSED BY _ _fit Ft~o�v --- � , ,.� -- 71t' - �� �2 RFMOVEABLE COVER n MANHOLE BROUGHT TO i �7:Y!J�`�I i'? hC✓�. .ss r, ✓ �v/ vri4�_a�.� - Sky r ti C 5`f li 11v V �Q � � ° . . ..;•..... .• e..• o, FINISH GRADE. . . , ,— .GMI�•t n „ { o - > ... . . .' 2 f'FASTONE� iLQ4MaFILL /2 MIN. r . 3 CLEAR ° 3 CLEAR, --- � _ _ �� �•T.Q _ � � •+. T'1� OUTLET PIPES -e - 1--- -t� _� �- -$-.:- cI ' AS REQU/RED DEPTH OF TEST - 6M/N__�-3"M/N• 6""M/N i I I T .e. ll 7 2 Mtt� �IMGN -- INLET i I� �� �L D/ST. RA TE' --— ---- - /0"MIN ( } f 1 I h• I - -- INLET TEE - - , i0!/TL£T TEE , L I '9 MED �,M 4"C./. 1000- GAL. INLET AND OUTLET 4 U"" MJh'lML/M OUTLET TEE DEPTH � 6 OGW EPT/C TA " I PRECAST OR BL MIN TEES TO BE CAST L/OUID DEPTH 14""AT LIOUIO DEPTH OF 4" S r -- 19"" , 5" /"" CONCRLTE SEEPAGE P/T - -- IRON, SCHED 40 , CONSTRUCT/GW 0' DEPTH of TEST., --- _ -- - 29'" " ;�.►- �,. -- MlN PVC OR CAST/N 24"" 6' .•� e v o . PLACE CONCRETE " - --- r RATE' _ _ - __— CONCRETE ._ 34 B' BOTTOM ON LEVEL STABLE BASE ��_ T A --- -- - i ��'(WATERT GH) • •. .,... . ,,. r.+ o, INLET TEE PROVIDED WHERE SLOPE FOUNDATION 1, ------------- OF e . .•,.t; ' . .•''. .. • .. INLET PIPE EXCEEDS 0.OB / OR -- -= - -------- �iF TANK TO BE ABLE TO WITHSTAND I • BOTTOM OF TANK ON LEVEL STABLE BASE IN A PUMPED SYSTEM. /y,,y I i H-/O LOADING UNLESS UNDER �•-- ---- - --- ----� /�'NjqSTONE � --- - -- --- --- - -- - ----- - - - -- -- ---- --- - I SHED • PAVEMENT OR/N OR/VE.H-20 I � L OA D l NG UNDER PAVEMENT OR I I 1 a " 47.4 - - DRIVE. NOTES : PLAN VIEW : I VER T EL E VA T/ONS: /. THIS PLAN/S FOR THE DESIGN AND CONSTRUCTION OF THE SEWAGE DISPOSAL FACIL/TYONLY. SCALE / �•� � �� INV AT BUILDING �tl,�of kq 2. A L L CONSTRUCTION METHODS AND MA TER/AL S SHALL CONFORM TO _.. _ _ ___ __ .-_._. __ _ __ _.__ _ ._ ____ .Y _.___.._-.___.__, .� � . �_�. �..____ ... � ._..__,._ . __.. � .�_: ., «w w ... _,F_.�_ v _ ��.._.._.:_.�_,ri,.W. - INV AT SEPTIC TANK i lN) MASS. D.E.Q.E. T/TL E 5 A ND THE �f?F,'V_:_�rA BOARD OF /� /N V. A T SEPTIC TANK(OUT) ,�� _ � � rP%NK HEALTH REGULATIONS. N� ti +;INl�. i•q, i y rs��ti �" c►vrc ,; INV AT DIST BOXON) 5 S_X(0 -INV AT DIST BOX(OUT) `5 C, , ,~ p ti / /0-L(_ - :� 14 f /0 Z6 9`p! J A T L EACHING FACIL I rY _S .t = -----=-_ ----- ------ - BOSTON, MASS. WORCESTER, MASS. AT BOTTOM Of-PIT.- 5-1_._4� HALIFAX, MAss. NORwELL, MASS. �� BEDFORD. MASS. LEXINGTON, MASS. ) HYANNIS, MASS. MANSFIELD, MASS, CRANSTON, R.I. DERRY. N H. " �=-�✓�., 1~' �`')F '�"°A.'�.' � h"`��.-h;�" i�0 79`v�-t c r Te.�f t�i r 4 !. 4 BE..IJ CN N1Af�1C ABC .L- 3. 11 N V D r R� DESIGN DATA j c_ . . .s. • ' DESIGN FLOW ilev r� y Q-F E h � �' f t ,.� Lfn - - -- E3 !E; IC: REQUIRED SEPTIC rANK! � � -3�nx Imo%, - 49 5_ - GAL J \�� '� SEPTIC TANK PROVIDED = so�c� GAL. CAPE COD SU RV E Y CONSULTANTb REQUIRED SIZE LEACHING FACILITY 1 �► + '� IN, -- - - - 3261 Main Street Route 6A Barnstable Village. Massachusetts 02630 �... .._ ,��, ';'---.. .. _ , - ___.-----•----' - - --3-�.Q-SAP�--- - _-_-_ f DIVISION F t �> BOSTON SURVEY CONSULTANTS INC. SIZE OF LEACHING FACIL/TYPROVIDED ENGINEERING SURVEYING PLANNING � TYPE-OF SYSTEM q' >iT W13 5TOuE TITLE: � •fir --- ----- — - ----- _z.lla_5 E-_x L 0 r __�_13_RD_ SEWAGE DISPOSAL SYSTEM - - DESIGN :.. , -1.. A ' LOCUS PLAN:Z . ,�••'�'' ,� � :a1 . . r,� H t� LOGVS R F? � "� '�� \ ;` �' FOR: PT 1�/f�:�: G GG.�+TF"f,;.) ti I�..1 7"H E C'��G`r,IV 6:a �/�,.! F�'C:i. .•'.:�� !���'. �`rJ 1�_ � �f I • , � r1�,; h• SCALE: AS SHOWN � �' 8S C "` �, �!.r' ► % METERS p J�' i r�'GZ�E 5.a/O11J 1siL 4,04,Al ZL)X-- ✓ * )"Of-- FEET 0 �,���Yti ?'F r.., <',\ ll DATE: '� 2 -, - \c.) `64 r� ` �\ , •L`'-<���`, �;•�,' `.•- ,`� COMP./DESIGN: ---------------------- �► CHECK: ' ��'E W R,pK DATUM' DRAWN: __— FIELD: i 7' 2 'S E..t~ 3, ► i FILE NO: DWG. NO: "l j JOB NO: o 3 ' 3 I 1 '1 SHEET: I OF: I